According to the Mayo Clinic, back pain is one of the top reasons for individuals to seek medical help from their physician and it is one of the leading causes of disability in the world. With the likelihood that most people will experience at least one bout of significant back pain within their lifetime, it seems worthwhile for individuals to understand the differences between some of the various terms used in diagnosing spinal issues, in order to receive the most effective treatments available for their specific condition. In this post, we will outline some basic spinal anatomy, along with defining terminology commonly associated with back pain and spinal discs in order to empower patients with knowledge about their particular condition.
The human spinal column is divided into several distinct areas. The cervical or neck region comprises the top of the spine closest to the skull, which connects to the thoracic or mid-back area, which in turn connects to the lower back or lumbar area. Below the lumbar area is the sacral region, which attaches to the end of the spinal column, often called the coccyx or tailbone. In the cervical, thoracic and lumbar regions there are a series of bones or vertebrae, separated by spinal discs. These spinal discs are made of an outer thick, rubber-like material housing a softer, jelly-like material inside. The vertebrae surrounding the discs provide structure and support to the spinal column, while the discs between the bones provide shock absorption capabilities during physical movement. The vertebrae connect to each other by way of facet joints, which also assist in spinal column movement. In addition, many vital nerves traverse through the spinal column, making the spine the main line of communication between the brain and the rest of the body.
A bulging disc is one that still has an intact outer layer of thick, fibrous material. However, as a person ages, this outer layer often weakens, enabling the disc to flatten somewhat, thereby bulging out into adjacent areas of the spine. Sometimes the bulging disc pushes against nearby nerves causing pain and discomfort. Most bulging discs occur in the lumbar area, although it is possible for bulging discs to turn up in the cervical and thoracic regions as well.
A herniated disc is generally considered a more severe condition than a bulging disc. With herniated discs, the tough outer layer of the disc tears, and the inner jelly-like disc material begins to leak out, often putting pressure on adjacent nerves. Herniated discs tend to show up in humans between the ages of 30 and 50, with a greater prevalence (2:1) in males vs. females.
A sequestered disc is one in which the inner material of a disc has leaked out and completely separated from the spinal column. This inner material may have completely separated from the disc, but it might still be close enough to put pressure on nearby nerves.
Protruding and Slipped Discs
Some physicians will use the term “protruding” to define a bulging disc, whereas others will use the term for a herniated disc. “Slipped disc” is generally a slang term used to describe a herniated disc. Overall, the most important point to remember about spinal discs is whether their outer disc layer is still intact or whether it has torn, allowing material inside to leak out and perhaps even separate.
Some physicians will have their patients get an X-ray of the area causing pain, whereas other physicians will skip X-rays and prescribe an MRI instead. In some cases, a physician will initially ask for an X-ray and then decide they need further information, in which case a patient will then receive an MRI. The MRI test is generally considered the gold standard of spinal testing, but even MRIs do not necessarily provide definitive answers in all cases.
Treatments and Symptoms
Treatments often depend upon the symptoms a patient experiences. In some cases, a bulging disc (or series of bulging discs) causes enough pain for an individual to seek treatment, whereas in other cases, many people don’t even know they have a bulging disc(s). Herniated discs may only cause mild pain, whereas in others a herniated disc will cause severe pain, numbness and tingling, and even weakness in the arms or legs. Generally speaking, physicians prefer to start out with conservative treatments such as pain relievers, applying ice or heat, and often a series of physical therapy treatments. If patients are exhibiting severe symptoms such as loss of bowel and/or bladder control, severe pain, weakness, or extensive numbness and tingling, they will often recommend surgery in order to relieve pressure on spinal nerves.
If you would like assistance in determining whether you have a bulging/herniated/sequestered disc we can help! In addition, we can recommend treatments other than surgery, injections, or prescription pain medications to help improve your symptoms. For more information, please contact the spine experts at Cawley PT and Rehab (570-208-2787), where you can speak to one of our Doctors of Physical Therapy or email us at firstname.lastname@example.org.
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